Provider Demographics
NPI:1871914259
Name:ALLEN, AMBER (DPM)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:PA
Mailing Address - Zip Code:18810-1817
Mailing Address - Country:US
Mailing Address - Phone:570-888-3668
Mailing Address - Fax:570-888-0354
Practice Address - Street 1:417 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:PA
Practice Address - Zip Code:18810-1817
Practice Address - Country:US
Practice Address - Phone:570-888-3668
Practice Address - Fax:570-888-0354
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2017-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006794213ES0131X
NYN006810213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400356881Medicare PIN